MR appearance of the normal and abnormal vagina after hysterectomy

To define the MR appearance of the vagina after hysterectomy, we reviewed the MR examinations of 43 women who had undergone hysterectomy for a variety of benign and malignant indications. In eight of the patients, MR examinations showed a mass lesion involving the vagina. The masses included four recurrent primary gynecologic malignant neoplasms (one endometrial, one ovarian, and two cervical carcinomas) and four primary vaginal carcinomas. The remaining 35 patients had no evidence of vaginal disease. Of these 35 patients, the repaired vaginal apex, or vaginal cuff, was linear and smooth in appearance in 23 and partially obscured by surgical clip artifacts in seven. In the other five patients, the vaginal cuff had a nodular appearance that was indistinguishable from a vaginal mass on T1-weighted images. However, the vagina had a normal appearance in these patients on T2-weighted images, on which the low-signal-intensity layer of vaginal smooth muscle could be distinguished from the bright outer layer of connective tissue. In patients with recurrent vaginal tumors, the tumor was relatively high in signal intensity on T2-weighted images and obliterated the low-signal-intensity vaginal muscularis. Our experience shows that the normal posthysterectomy vagina may have a nodular appearance on T1-weighted images mimicking a vaginal mass. This appearance can be distinguished from that of a true vaginal mass on the basis of different signal intensity characteristics on T2-weighted images.